Cristero

You clearly have a bias and failing to understand how the research and studies works. Just for your information, a metanalisys is a collection of several studies and it's considered superior to a single study, as it collects data from several sources throughout the years. The source you cited is still doing a connection between DHT and prostate cancer, which has been found to be obsolete in the second metanalisys I've sent you. I guess you didn't even open it. That doesn't invalidte all it says there, but clearly shows the doctor you quoted is failing to keep himself updated. In any case, there's no point on keeping discussing it. It's the usual self-defensive attitude of finasteride users. They don't want to hear the fact that they are possibly jeopardizing their health for the sake of a band aid that won't prevent them to eventually get bald anyway.

You are using just one source. This metanalisys contradict your source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6358277/#:~:text=The role of 5α-reductase,risk in high-grade disease. Ypu may want to read the biggest metanalisys of studies on DHT I'm aware of, that shed light on the role of DHT in prostate cancer, which is dubious by now: https://academic.oup.com/edrv/article/38/3/220/3788611

As another user said, people are ignoring senile alopecia. Your donor won't be the same at 40 as it was at 20. Hairs are organs and they age like all the rest of the body. I've personally asked Dr. Rassman because I saw with a microscope some miniaturized hairs on my occipital area (mostly one hair on a double graft). He told me he sees it quite frequently when "guys turn into men" and not to be worried about it. Donor miniaturization could be due to other causes, like lack of iron, low vitamin D levels, hypothyroidism etc. But yeah, let's ingest an anti-androgen like if it was a candy to thicken 200 hairs on the donor.

I'm glad you brought up the matter and mentioned that the issue with finasteride is not only sexual side effects. 5-ar is rich in some tissues for a reason. Not many people knows that 5-ar inhibitors have been trialed as treatment fro prostate cancer, in order to try to target the androgens in the prostate in the early 2000s. We now know that prostate cancer is way more complex than just saying androgens is the cause. There are prostate cancers that are resistant to complete prostate androgens deprivation. In any case, finasteride and dutasteride didn't get approved for the treatment of prostate cancer, because not only they were ineffective, but they actually showed to be possibly trigerring a far more aggressive cancer prostate than the one they were supposed to treat. I've seen a recent study done to try to debunk that, but it didn't convince me at all.

The reason is because your body experiences a really slow androgens decrease with time. In a healthy male, the avreage is a decline of 1% of testosterone every year, one you reach your 30s. Older men are accustomed to live with lower androgens and may suffer less the introduction of an anti-androgen at later stage, especially because they don't expect to perform as a guy in his 20s in every field of their life (not just sexually).

Dude you are confused to say the least. I'm not gonna get into a discussion on this topic, because this is seriously endocrinology 101. Cortisol doesn't suppress the HPTA and doesn't require any induced restart of the axis. If you want to know how the HPTA works and what happens when it gets suppressed, google "secondary hypogonadism in men". As I said before, I'm done with this conversation until we will get the Breezula phase 3 data from Cassiopea. What came out from the Winlevi trials on young adults is alarming to say the least for now.

HPTA suppression is way worse than any sexual side effects. It seems you don't know much about it and I'm glad for you that you didn't experienced it, but that basically means you don't have any considerable amount of sexual hormones running in your body anymore, both androgens and estrogens. Not only you will be unable to perform sexually, but you will experience a terrible depression and sometimes even suicidal thoughts. Try to ask any bodybuilder who failed to do a proper PCT protocol after a steroid cycle. In any case, we will discuss again when we will have the data from the completed phase 3 of the hairloss topical.

Dude, I don't want to sound harsh, but the pictures you provided and the numbers you posted are telling a different story. In any case, I wish you the best and I guess we have given you our opinion regarding your choice of jumping on finasteride. You are a grown up and you can do an informed decision. Hopefully you will be able to achieve the density you are after with or without finasteride. Good luck for everything.

Finasteride won't prevent your hairloss for sure. Period. It will give you some more years, but if you don't target all the other pathways, you will lose them eventually. Finasteride is only a band aid. A quick look at hairlosstalk forum will prove you that.

Look, I'm not trying to say I know the answer and you don't. Completely the opposite actually. I'm saying we BOTH don't know the answer. I was considering the case of @Portugal25. He's losing hairs in a standard horse shoe pattern. We are not talking about the donor getting thinner overall, we are talking about areas going completely bald, while the rest of the donor staying thick. So, to stay in topic, he just needs a surgeon to harvest in the safe area in HIS case and he won't need to take finasteride. His hairs when transplanted will stay thick, unless we are embracing the fibrosis/scalp tension theory. You have surgeons on one side telling you the result are permanent, while some people claiming they lost their transplanted hairs. As you saw from Portugal pictures though, his own case judgement was biased. He didn't even lose transplanted hairs, at least from what we can assume from the pictures and the numbers he gave us. Do we have studies where they followed people with a hair transplant for more than 10 years?

So this demonstrates that what you and @Rolandas were saying is basically false. Transplanted hairs, taken from the safe part of the donor area, are immune to miniaturisation. The reason why Pekiner advise you to take finasteride is because you have a precedent on your family which had an AGA progressing quite extensively in the occipital area. This doesn't mean that transplanted hairs are not immune to DHT, but simply that your AGA is progressing quite aggressively in the occipital area. Which is what I've been trying to tell you since the beginning. Dr. Rahal harvested too high in YOUR case. If you showed him a picture of your uncle, he did a big mistake then.

Amen

So one of the two is lying, tertium non datur (as the Romans were saying): https://www.realself.com/question/california-md-dupa-hair-loss Thanks for showing your pictures, but as the other user said, there's no chance that was 70 grafts per cm2. You would have looked really dense. I don't know what happened really, but I think you just kept losing your native hairs. In any case, let's assume what they told you was correct. You said you started from 70 hairs per cm2 after the first HT and ended up with 30 hairs per cm2 before Pekiner's HT. That would have meant that you lost almost 60% of your hairs you used to have. This means you lost all the native plus more than 20% of your transplanted. As you can see from the link posted above, that would have implied you had DUPA, since more than 20% of the occipital hairs miniaturised. But we know for sure you don't have DUPA, so something else must have happened. From what I can grasp at the moment, there are 2 possibilities then: either Rob English's theory about scalp tissue is correct, implying that even hairs in the donor area when implanted in fibrotic tissues start miniaturising, or you just retained your transplanted hairs and lost all your native hairs, which means you were quite far from having 70 hairs per cm2. I tend to lean towards the second option.

Well, I guess you didn't read my comments then. I never said no one should ever take finasteride for hair loss. I said there's no point for a NW7, because no one that doesn't have DUPA will ever go bald or visibly thinning out on the donor. I think we can at least agree on it. He's exposing himself to an anti androgen for what would mostly be a minimal gain. Then obviously it's his call. Just as a word of advice, in the first years taking finasteride, was like ingesting a placebo pill. No side effects whatsoever. The problem is when you're exposing yourself to the drug for the rest of your life, considering, as I've already said, that your hormonal profile will be completely different in your 40s than your 50s.

Which means vast majority of surgeons in the world have fooled us saying the donor area is immune to DHT. The very same doctors you took your finasteride dosage from (the ones from The Hairloss Show) says the transplanted hairs are permanent and refuses to do juveniles hairlines on a big chunk of their patients, because they say they will keep their hairs on the hairline while keep receding in the mid and crown. Out of curiosity, can you share a picture of your scar during your first FUT? I'm curios to see where they harvested. Regarding Dr. Lorenzo, being a good surgeon doesn't make you an experienced endocrinologist or dermatologist. He just says what he thinks it could work, but there's no literature on donor hairs and finasteride (or at least I'm not aware of it). Dr. Rassman, the one who labeled DUPA 20 years ago, says there's no treatment for it and refuses to proceed to surgery. So once again, 2 surgeons contradicting themselves. There are studies and articles done by SITRI, the Italian dermatologists society, which demonstrated how the female diffuse alopecia pattern is due to lack of tissue estrogens, in particular estriol. That could be a field to investigate for DUPA for example. In any case, how many men have you seen going diffuse thinning or completely bald in the donor area? Personally, no one. So, even if your logic would be correct and finasteride will improve your donor, how much would you expect to gain from that? 10% more hairs? Is it worth it the side effects, especially because you're not in your 20s anymore and your HPTA is slowing down by itself already, exposing you to a lower androgen index in your body? To conclude, I can tell you by experience there is no proven dosage for any hormonal inhibitor. I've seen many blood works in these years by people taking aromatase inhibitors (which works the same way as 5-ar inhibitors) and the very same dose produced completely different outcomes in terms of serum levels. They are both paracrine hormones and their serum levels are irrelevant. You would need to do a scalp biopsy before and after to see how much that dose is lowering your scalp DHT.

That would apply to you as well, since you're using it after Dr. Ferreira suggestion. It's human psychology to defend something your are putting your faith on. I hope you did your extensive research at least before ingesting an anti-androgen. Don't trust whatever a doctor will tell you. Hair loss forums are full of delusional trying to defend finasteride even when faced with evidences and basic endocrinology and pharmacology knowledge. On the other side you have people who got bad experiences that blame everything on finasteride, even if it's completely unrelated. My stance is in the middle: if you're losing your mind after your hair loss, then definitely try. If you don't get side effects, it will retain your hairs for a decade, maybe 15 years. But for a NW7, I seriously don't understand. If @Portugal25did FUT I don't know then. I would assume could be something related to how the surgery has been performed, but I don't really know. It is out of my field of expertise.

Believe what you want, I couldn't care less. You won't believe it even if I show you the blood tests before and after. Juts for the record, look for the user Mustang on hair loss talk. Same experience as mine and other users on Italian forums.

Because I've been doing blood tests since I was in my early 20s and I'm in my 30s now. Until last year I was doing extensive blood work every month. Find me anyone else spending so much money on lab works. Is that enough as an evidence?

It means that miniaturization in the donor is something that even people without AGA sometimes have. It's a normal aging process, unrelated to what's happening on top of your head. Just to be clear, Dr. Rassman is the surgeon who invented the word DUPA, so not really the last surgeon on earth. You quoted just one study. I saw several during the years and the numbers are all over the place. DHT is a paracrine hormone, you will see different reductions according to the time of the day the sample is drawn, the age and the health situation of the patient. That's why I said 40% on average. About the efficacy of finasteride on the donor area, is complete speculation. We have been told for years the hairs on the safe area are immune to DHT, so why bothering with finasteride? The options are 2 then: they either lied to us and they are not immune, so HT is a not long term option, or the people who lost their hairs extracted from the safe area have or developed DUPA afterwards, so a HT should have not performed in any case. Discontinuation of 5-ar inhibitors doesn't mean complete recovery in several guys and we know it quite well by now. I personally became hypogonadal after 7 years of the drug and I'm on TRT for life. So it's not that easy as you are describing it and chances of side effects are higher and higher the more you age, since the androgens load in the body goes lower and lower due to aging.

I agree with @Melvin-Moderator. Both your friend @Rolandas and @Portugal25 would have lost their transplanted hairs anyway, because they were extracted too high in the occipital area. Especially with @Portugal25, it's clear his occipital area baldness went pretty low on what you would see on many men. I saw pictures of extractions in several patients and a good amount of surgeons extract very high. You're describing finasteride like if it's the Holy Grail. Many people can't even maintain with finasteride, as the oral version inhibits DHT a roughly average of 40% in the scalp. Without even mentioning that testosterone miniaturises as well, around 5 fold less than DHT. And, as shown by studies done years ago by Italian thricologists, the androgen receptors are more sensible to testosterone than DHT on the hairline. Dr. Rassman told me personally that he sees miniaturised hairs in the donor quite frequently in men in their 30s, as it's a normal aging process. Taking finasteride on a former NW7 is totally non-sense, especially if he had beard grafts transplanted.

It's crazy you managed to keep your hairs with only 20 mg of clascoterone. I'm using 150 mg everyday in one application at night, along with adenosine as a growth agonist. I also dermastamp once a week and I'll probably add 17-a estradiol and Azelaic Acid after the HT. It seems your hairloss was pretty mild and maybe it would have stopped by itself after reaching NW 3

I had a terrible shed for 2 months when I started clascoterone which I never had with anything else, but despite the shed, my hairs are looking better. I'm only taking 140 mg per week, that puts me on high end physiological range. I'm able to maintain with clascoterone at the moment and I'm supposed to have a first hair transplant soon hopefully. We will see how it will behave in the next years. Did you manage to maintain with clascoterone during the years? What Norwood are you and how aggressive was you AGA?

This was supposed to be a safe alternative to finasteride finally, especially for young guys wanting to avoid taking finasteride before their 20s. I'm afraid to tell you HPTA axis suppression is way worse than killing 5-ar. Just to be clear, HPTA suppression happens with exogenous androgens or several anabolic substances, like nandrolone. After using them, you need to use a post cycle treatment in order to restart your HPTA. Having secondary hypogonadism and being on TRT for the rest of my life thanks to finasteride as well, I can't just shrug my shoulders, pretending this is not alarming. And I don't even believe everyone will be fine after 4 weeks, just stopping the medicatioN. This is a huge disappointment. That being said, I'm using it since a while to maintain my hair while on TRT, because I can't touch 5-ar inhibitors anymore, and I have 0 side effects. But in my case the HPTA is already suppressed, since I'm using exogenous testosterone.

While I agree with you on finasteride, you're quoting the Cassiopea's press release wrong. Taken from this one: https://www.cassiopea.com/2020/08/27/cassiopea-receives-fda-approval-for-winlevi-clascoterone-cream-1-first-in-class-topical-acne-treatment-targeting-the-androgen-receptor/ Hypothalamic-pituitary-adrenal (HPA) axis suppression may occur during or after treatment with WINLEVI. In the PK trial, HPA axis suppression was observed in 1/20 (5%) of adult subjects and 2/22 (9%) of adolescent subjects at Day 14. All subjects returned to normal HPA axis function at follow-up 4 weeks after stopping treatment. Conditions which augment systemic absorption include use over large surface areas, prolonged use, and the use of occlusive dressings. Attempt to withdraw use if HPA axis suppression develops. It clearly says adults and actually it was even worse with teenagers.

It's not prescribed in Italy, because the drug for hair loss just completed phase 2 and not even started phase 3. If you want it, you have to order it from research labs and it's pretty expensive. I'm doing like that. I would be cautious with saying that it doesn't have side effects, as Cassiopea clearly stated in their press release that 1 guy out of 20 got HPTA axis shutdown, which is way worse than finasteride. Good news is that it was reverted after 4 weeks.